Characteristics of selected studies.

BackgroundThis study assesses the incidence of ICU-acquired weakness (ICUAW) among patients using kidney replacement therapy (KRT) and explores the uncertain relationship between KRT and ICUAW in critically ill adult patients.MethodsA comprehensive search was conducted across PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials up to June 10, 2024. Inclusion criteria encompassed randomized controlled trials (RCTs), as well as prospective and retrospective cohort studies that examined the correlation between KRT and ICUAW in adult ICU patients. Heterogeneity was evaluated using the χ² and I² statistics. Publication bias was assessed qualitatively via funnel plots and quantitatively using Begg’s and Egger’s tests.ResultsA total of twelve cohort studies involving 2275 adult patients were included, with no RCTs meeting the criteria. The overall incidence of ICUAW was 49.5% in patients using KRT, compared to 34.8% in non-KRT controls. These studies collectively demonstrated a statistically significant association between KRT and a higher incidence of ICUAW (OR, 2.12; 95% CI, 1.34–3.34). Subgroup and sensitivity analyses reinforced this association, particularly in studies involving patients with clinical weakness, large sample sizes, and low risk of bias. However, studies focused on patients with abnormal electrophysiology and small sample sizes did not show this correlation. Despite the substantial findings, statistical heterogeneity was present. No significant publication bias was detected.ConclusionThis study highlights a significant association between KRT and an increased incidence of developing ICUAW.【研究背景】本研究旨在评估接受肾脏替代治疗（kidney replacement therapy, KRT）的患者中重症监护病房获得性肌无力（ICU-acquired weakness, ICUAW）的发生率，并探讨重症成年患者中KRT与ICUAW之间尚不明确的关联。 【研究方法】本研究于2024年6月10日前，在PubMed、Embase、Web of Science及Cochrane对照试验中心注册库中开展全面文献检索。纳入标准涵盖针对成年ICU患者KRT与ICUAW相关性的随机对照试验（randomized controlled trials, RCTs）、前瞻性队列研究及回顾性队列研究。采用卡方（χ²）检验与I²统计量评估研究间异质性，通过漏斗图进行定性评估发表偏倚，并借助Begg检验与Egger检验开展定量分析。 【研究结果】最终共纳入12项队列研究，涉及2275名成年患者，无符合纳入标准的随机对照试验。接受KRT的患者中ICUAW总发生率为49.5%，而非KRT对照组的发生率为34.8%。综合分析显示，KRT与ICUAW发生率升高存在统计学意义上的显著关联（比值比（odds ratio, OR）=2.12；95%置信区间（95% confidence interval, 95% CI）：1.34~3.34）。亚组及敏感性分析进一步验证了该关联，尤其在纳入临床肌无力患者、大样本量及偏倚风险较低的研究中更为显著。但针对电生理异常患者及小样本量的研究未观察到此类关联。尽管本研究得出了有价值的结果，但仍存在统计学异质性，且未检测到显著的发表偏倚。 【研究结论】本研究证实，KRT与ICUAW发生率升高存在显著关联。